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Business-Minded PA Ideally Suited for ACO

Learn more about emerging models of care established by the Affordable Care Act at AAPA’s Navigating Healthcare page.

Steward Health Care, a Pioneer accountable care organization (ACO) and the second-largest healthcare system in New England, has embraced physician assistants at every level of its organization. Heather Trafton, MBA, PA-C, Steward’s director of performance, is an example of this.

Trafton bridges the knowledge gap between policymakers and healthcare providers within the ACO’s healthcare network. Steward’s network is comprised of 10 hospitals with 2,500 physicians and several hundred PAs. This relatively new role for Trafton, who previously served as Steward’s director of clinical integration, is responsible for overseeing provider quality and continuing medical education, and clinical integration and education.

Trafton’s experience throughout her career as a PA leader prepared her for the world of insurance plan negotiations and educating other health professionals on the performance measure requirements for the ACO. In addition to her training, education and experience as a PA, she also has an MBA and has served as legislative coordinator for the Massachusetts Association of Physician Assistants.

Trafton credits her clinical experience working with physicians for her ability to successfully communicate with them as an administrator, especially when it comes to explaining the complexities of ACO requirements.

“Physicians are more likely to respond to me,” she says, “because I speak their language.”

As a Pioneer ACO, Steward is responsible for a large at-risk population, including members of its own HMO system and those who access its network through the Massachusetts Connector online healthcare marketplace. It also contracts with Blue Cross Blue Shield, which outlines quality metrics for which the network is responsible and appropriately compensated.

Success for ACOs is measured by outcomes, and Steward is keenly interested in coordinating care for patients with chronic diseases and multiple comorbidities. Using a community care-based model, PAs and other primary care providers may refer patients to local resources to improve the patient’s overall health. For example, a PA might refer a patient diagnosed with Type 2 diabetes to a program that provides patients with 15 education sessions on disease management. Patients in this program have access to a dietitian and a nurse who can help with insulin titration and nutrition education. This decentralized approach suits the unique nature of the Steward network, which is comprised of many small practices dispersed throughout more than 150 communities, as opposed to a centralized system under one campus. PAs also participate in group-based patient visits to address the needs of their diabetic and cardiac disease patients.

Steward has been successful in assuring that patients receive the appropriate preventative care screenings such as mammograms and colonoscopies, and it has assembled teams of health professionals to prevent hospital readmissions. For example, a pharmacist and a nurse may visit a patient’s home after discharge and report on the patient’s health status to the patient’s PA or other primary care provider. This seamless follow-up care helps to avoid readmission or target patients at risk for complications.

According to Trafton, Steward is interested in becoming a destination for PA practice. The president of Steward’s Hospitals, Mark Girard, would like to increase the number of PAs and maximize utilization of existing PAs. PAs in Massachusetts are included in the statutory definition of primary care providers, leading Steward to look into integrating PAs into contracted rates and having PAs accountable for the network’s quality measures.

The PA future is bright at Steward, and Trafton sees PAs playing a huge role in increasing access to patient care within the ACO, especially in the outpatient and ambulatory surgical setting. As it strives to be a truly clinically integrated system based on population health, Steward is working with clinicians to set its own patient outcome goals and measures before policymakers—with no knowledge of the patient population—set them.

Trafton sees her position as the perfect blend for the business-savvy PA who is interested in marrying clinical experience with an understanding of risk management and provider negotiations.

“As a PA, you live in the middle, between the patient, the nurse and the surgeon—so this role is ideal,” she says. “You learn to navigate and adapt to your audience to assure effective communication and coordination of patient care.”